Results of Proactive Surgical Clipping in Poor Grade Aneurysmal Subarachnoid Hemorrhage: Pattern of Recovery and Predictors of Outcome.

Related Articles

Results of Proactive Surgical Clipping in Poor Grade Aneurysmal Subarachnoid Hemorrhage: Pattern of Recovery and Predictors of Outcome.

World Neurosurg. 2017 Mar 27;:

Authors: Das KK, Singh S, Sharma P, Mehrotra A, Bhaisora K, Sardhara J, Srivastava AK, Jaiswal AK, Behari S, Kumar R

Abstract
BACKGROUND: The outcome associated with the treatment of poor grade aneurysmal subarachnoid hemorrhage (p SAH) is rather discouraging. Even then, some patients may survive, the long term outcomes and the patterns of recovery of these survivors, however, has not received much attention in the literature.
METHODS: 85 patients (mean age 53.3 years, M: F= 34:51, 98 aneurysms) with post resuscitation Hunt and Hess grades 4 and 5 subarachnoid hemorrhage were studied. Modified Rankin Scale score was used to determine the functional outcome. Different factors were analyzed using uni and multivariate models for their effect on the functional outcomes after surgery.
RESULTS: 23 patients died in the 30-day perioperative period while eight patients died at follow-up (n=31, 36.5%). Nearly 35% and 51% of the survivors obtained favorable short and long term functional outcomes respectively. The presence of a space occupying hematoma (p=.014) and the functional status at discharge significantly affected the long-term functionality (p=.004) in our patients. The functional improvement was steady with time (the probability of good outcome at about 2 months of discharge was around 65%, about 55% at 1 year and 40% at 2 years and then achieved a plateau).Marked improvement occurred in 11% survivors even after 18 months.
CONCLUSION: If operated at the earliest opportunity after admission, meaningful survival may be provided to a significant number of patients. The recovery process in the survivors is a dynamic process and considering the late improvements in some, it is advisable be follow them beyond the conventional end points.

PMID: 28359925 [PubMed - as supplied by publisher]

http://ift.tt/2nHsJem